Provider Demographics
NPI:1912593203
Name:SHADRICK KRALIK MD PA
Entity Type:Organization
Organization Name:SHADRICK KRALIK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHADRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KRALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-315-9155
Mailing Address - Street 1:2198 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6024
Mailing Address - Country:US
Mailing Address - Phone:941-315-9155
Mailing Address - Fax:727-674-1317
Practice Address - Street 1:2198 MAIN ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6024
Practice Address - Country:US
Practice Address - Phone:941-315-9155
Practice Address - Fax:727-674-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty